Provider Demographics
NPI:1013723048
Name:BEDROCK PSYCHIATRY
Entity type:Organization
Organization Name:BEDROCK PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-725-0205
Mailing Address - Street 1:PO BOX 241248
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0005
Mailing Address - Country:US
Mailing Address - Phone:501-725-0205
Mailing Address - Fax:
Practice Address - Street 1:1405 N PIERCE ST STE 212
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5357
Practice Address - Country:US
Practice Address - Phone:501-725-0205
Practice Address - Fax:254-212-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty